Initiating and responding to joint attention bids in children with autism: a review of the literature

Characterization of dyadic interaction features between fathers and mothers playing with their autistic children

BACKGROUND

Socio-communicative difficulties are a core symptom of autism that deeply impact interaction with others. Despite that, research on bidirectional caregiver-child interaction variables has been notably scant and predominantly focused on autistic children's interactive differences and the consequences on parenting behaviors.

AIM

The study aimed to assess parent-child interaction in the context of autism through observational validated instruments that consider qualitative and structural features in a complementary way to obtain a comprehensive characterization of the exchange within the dyad.

METHODS AND PROCEDURES

This study involved 56 paired parent-child dyads of 28 autistic children (mean age = 38.60 months, sd = 9.50) playing with their mothers and their fathers for 10 min. The video-recorded sessions were coded through the Emotional Availability Scales (EAS) and the Interpersonal Synchrony (IS) coding system.

OUTCOMES AND RESULTS

Fathers and mothers do not show significant differences in ISexcept for mother widenings, which are more frequent and successful, and in Emotional Availability. Further, dyads present moderate levels of Emotional Availability, indicating that parents may struggle with structuring, sensitivity, and interactive abilities with their autistic children, which in turn present low levels of responsiveness and involvement. Further, we explored an association between IS and EA characteristics.

CONCLUSION AND IMPLICATIONS

This study suggests the need for interventions to target interaction considering both caregivers, ultimately targeting both interaction structure and affect features. Research that includes fathers fosters strategies for individualization and treatment optimization.

Correlation Between Gaze Behaviors and Social Communication Skills of Young Autistic Children: A Meta-Analysis of Eye-Tracking Studies

This meta-analysis examined correlations between eye-tracking measures of gaze behaviors manifested during dynamic salient social stimuli and behavioral assessment measures of social communication skills of young autistic children. We employed a multilevel model with random effects to perform three separate meta-analyses for correlation between social communication skills and (a) all gaze behaviors, (b) gaze duration, and (c) gaze transition. Subsequently, we performed meta-regression to assess the role of four moderators, including age, continuum of naturalness of stimuli, gaze metric, and area of interest, on correlation effect sizes that were heterogeneous at the population level. A total of 111 correlation coefficients from 17 studies for 1132 young autistic children or children with high-likelihood for autism (Mage range = 6-95 months) were included in this meta-analysis. The correlation effect sizes for all three meta-analyses were significant, supporting the relation between improved gaze behaviors and better social communication skills. In addition, age, gaze metric, and area of interest were significant moderators. This suggests the importance of identifying meaningful gaze behaviors related to social communication skills and the increasingly influential role of gaze behaviors in shaping social communication skills as young autistic children progress through the early childhood stage. The continuum of naturalness of stimuli, however, was revealed to trend towards having a significant moderating effect. Lastly, it is important to note the evidence of potential publication bias. Our findings are discussed in the context of early identification and intervention and unraveling the complex nature of autism.

A wearable device-enabled therapeutic approach to improve joint attention in autism spectrum disorder: a prospective pilot study

It has been previously proposed that interventions aimed at integrating and co-activating music processing and motor control systems could have therapeutic potential for priming social skill development in children with autism spectrum disorder (ASD). In this study, we assessed this hypothesis through a wearable sensor platform called Ambulosono ("Ambulo"-walk; "sono"-sound) in which pleasurable children's musical stimuli are contingently linked to effortful motor action (locomotor step size), thus creating a motivational state proposed to be conducive to joint attention (JA) operation. Five participants were recruited from a community-based partner and were assessed by scoring responses following therapist-directed bids for JA. Multiple assessment sessions through a repeated time-series design were conducted to determine baseline and post-intervention scores. The intervention session consisted of approximately 15 min of Ambulosono exposure. Baseline and post-intervention data were aggregated and analyzed using a linear mixed-effect model. The wearable sensor and wireless headphones of the Ambulosono system were tolerated by the participants, and there were no adverse effects associated with the use of the device. We found an increase in the average responses to bids for JA during the Ambulosono intervention phase compared to baseline across participants. This increase did not appear to result from enhanced general arousal. Our pilot data support feasibility and further testing of Ambulosono as a therapeutic aid for integration into community-based ASD programs to augment shared child-therapist social interactions.

Comparing the effectiveness of robot-based to human-based intervention in improving joint attention in autistic children

Background

Children with autism have impairments in initiation of joint attention (IJA) and response to joint attention (RJA).

Aims

The present study compared the learning effectiveness of robot-based intervention (RBI) with that of content-matched human-based intervention (HBI) in improving joint attention (JA). We examined whether RBI would enhance RJA, in comparison to HBI. We also examined whether RBI would increase IJA, in comparison to HBI.

Methods and procedures

Thirty-eight Chinese-speaking children with autism aged 6 to 9 years were randomly assigned to RBI and HBI groups. Before intervention, their autism severity, cognitive abilities, and language skills were assessed. Each child received six 30-min training sessions over 3 weeks. During training, he/she watched one or two robot/human dramas twice where two robot/human actors demonstrated eye contact and RJA.

Outcomes and results

Children in the RBI (but not HBI) group produced more RJA and IJA behaviors in the delayed post-test than in the pre-test. Parents of the RBI children rated the program more positively than those of the HBI children.

Conclusions and implications

RBI may be more effective than HBI in promoting JA in autistic children with high support needs. Our findings shed light on the application of robot dramas in enhancing social communication skills.

Robot dramas may improve joint attention of Chinese-speaking low-functioning children with autism: stepped wedge trials

INTRODUCTION

Children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention. Previous research has found that these children are interested in engaging with social robots.

PURPOSE

In the present study, we designed a robot drama intervention for promoting responses to joint attention abilities (RJA) of children with low-functioning autism (IQs < 70).

MATERIALS AND METHODS

Using a stepped wedge design, Chinese-speaking children aged six to eight were randomly assigned to three tiers (N = 18). Children of all three tiers had comparable autism severity, language and cognitive function, and joint attention abilities. Tier 1 first received intervention, followed by Tiers 2 and 3. They watched six dramas in which social robots demonstrated RJA behaviours.

RESULTS

The RJA of children of all tiers improved after intervention and such improvement was maintained over time. Despite initiation of joint attention (IJA) not being explicitly taught, IJA of all children was found to improve after intervention.

CONCLUSIONS

It was, therefore, concluded that a robot drama could enhance the joint attention of children with low-functioning ASD.Implications for rehabilitationIn comparison to typically developing children, children with autism spectrum disorder (ASD), especially those with low cognitive functioning, have deficits in joint attention.Robot-based drama intervention program was developed to promote responses to joint attention (RJA) abilities of children with low-functioning autism (IQs < 70).Modelling RJA in robot dramas can promote RJA abilities in these children.An improvement in RJA also yielded an increase in the initiation of joint attention (IJA) abilities.Children with low-functioning autism might be able to extract the initiation of joint attention skills from the drama, even though these behaviours were not explicitly taught.

The development and psychometric assessment of communication skills checklist for 6- to 24-month-old Persian children

Prelinguistic skills play an important role in children's communication development. These skills are considered as significant bases for language acquisition and function conductive to later social development. Means of communication, communicative functions, skills with cognitive bases, and language comprehension are important prelinguistic skills. There is a critical period for acquiring prelinguistic skills and early identification of communication deficits is an important issue to be considered. The present study aimed to develop a communication skills checklist for Persian children aged 6- to 24-month-old and evaluate its psychometric properties. Parents of 277 Persian children aged 6- to 24-month-old participated in the current study. A checklist was first developed after an extensive literature review and various psychometric analyses in addition to regression analyses were carried out to determine its validity and reliability. The final checklist contained 36 items with high face validity and content validity (CVI > 0.62, CVR > 0.79). Also, the checklist demonstrated a high association with the CNCS (Pearson's correlation coefficient = 0.85, p < 0.001), and the construct validity showed significant differences between the four age groups (F-test = 197.881, p < 0.001). The results of the internal consistency measurement (Cronbach's alpha coefficient = 0.952) and the test-retest reliability test (ICC = 0.933, p < 0.001) revealed excellent reliability of the checklist. In conclusion, based on the psychometric assessment, this checklist is a promising tool for assessing communication skills in Persian children aged 6 to 24 months.

Parent-child interaction during the first year of life in infants at elevated likelihood of autism spectrum disorder

Autism spectrum disorder (ASD) likely emerges from a complex interaction between pre-existing neurodevelopmental vulnerabilities and the environment. The interaction with parents forms a key aspect of an infant's social environment, but few prospective studies of infants at elevated likelihood (EL) for ASD (who have an older sibling with ASD) have examined parent-child interactions in the first year of life. As part of a European multisite network, parent-child dyads of free play were observed at 5 months (62 EL infants, 47 infants at typical likelihood (TL)) and 10 months (101 EL siblings, 77 TL siblings). The newly-developed Parent-Infant/Toddler Coding of Interaction (PInTCI) scheme was used, focusing on global characteristics of infant and parent behaviors. Coders were blind to participant information. Linear mixed model analyses showed no significant group differences in infant or parent behaviors at 5 or 10 months of age (all ps≥0.09, d≤0.36), controlling for infant's sex and age, and parental educational level. However, without adjustments, EL infants showed fewer and less clear initiations at 10 months than TL infants (p = 0.02, d = 0.44), but statistical significance was lost after controlling for parental education (p = 0.09, d = 0.36), which tended to be lower in the EL group. Consistent with previous literature focusing on parent-infant dyads, our findings suggest that differences between EL and TL dyads may only be subtle during the first year of life. We discuss possible explanations and implications for future developmental studies.

Resting and Functional Pupil Response Metrics Indicate Features of Reward Sensitivity and ASD in Children

The current study examined the relationship between quantitative measures of reward and punishment sensitivity, features of autism spectrum disorder (ASD), and resting and functional pupil response metrics across a clinically heterogeneous sample. Scores on a parent-report measure of punishment and reward sensitivity were correlated with ASD features. We also assessed whether pupil measurements could be used as a physiologic correlate of reward sensitivity and predictor of ASD diagnosis. In a logistic regression model, pupil dilation metrics, sex, and IQ, correctly classified 86.3% of participants as having an ASD diagnosis versus not. This research highlights individual differences of reward sensitivity associated with ASD features. Results support the use of pupil metrics and other patient-level variables as predictors of ASD diagnostic status.

Theory of Mind Deficits and Neurophysiological Operations in Autism Spectrum Disorders: A Review

Theory of Mind (ToM) is a multifaceted skill set which encompasses a variety of cognitive and neurobiological aspects. ToM deficits have long been regarded as one of the most disabling features in individuals with Autism Spectrum Disorder. One of the theories that attempts to account for these impairments is that of “broken mirror neurons”. The aim of this review is to present the most recent available studies with respect to the connection between the function of mirror neurons in individuals with ASD and ToM-reflecting sensorimotor, social and attentional stimuli. The majority of these studies approach the theory of broken mirror neurons critically. Only studies from the last 15 years have been taken into consideration. Findings from electroencephalography (EEG) studies so far indicate that further research is necessary to shed more light on the mechanisms underlying the connection(s) between ToM and neurophysiological operations.

The impact of person–environment–occupation transactions on joint attention in children with autism spectrum disorder: A scoping review

Introduction

Individuals with autism spectrum disorder demonstrate difficulty with joint attention, affecting social and occupational performance. Studies of joint attention in children with autism spectrum disorder employ a variety of instrumentation, environments and occupations. From the occupational therapy perspective, current literature lacks a rigorous analysis of the transactions of person, environment and occupation embedded within the procedures of these studies. The goal of this scoping review was to investigate how these components transact to affect occupational performance.

Method

Using the Person–Environment–Occupation model as an evaluative lens, a scoping review was completed to summarize person, environment and occupation transactions in studies examining joint attention in children aged 6–12 years with autism spectrum disorder.

Results

Six studies were included. Findings indicated that simplified social environments and demonstrations of joint attention promoted higher joint attention performance in children with autism spectrum disorder, at the cost of ecological validity. Maintaining ecological validity in complex social environments resulted in lower joint attention performance.

Conclusion

The Person–Environment–Occupation model can be used to develop an occupational therapy perspective on literature from outside the discipline. There is a relationship between the person, environment, occupation transactions and joint attention in children with autism spectrum disorder.

Initiation and response of joint attention bids in autism spectrum disorder children depend on the visibility of the target

BACKGROUND AND AIMS

Response to joint attention (RJA) and initiation of joint attention (IJA) are impaired in pre-schoolers with autism spectrum disorder (ASD). Children's response to joint attention may depend on the presence of the target in the child's field of vision or on the type of deictic index (head and eye orientation, pointing and verbalisations) used by the adult to initiate joint attention.

METHODS

This study deals with 50 ASD children aged from 2 years 8 months to 11 years 7 months, with a communicative level comparable to children under 31 months of age, according to the French version of the Early Social Communication Scales (ECSP, by its French acronym). We compared the aforementioned ASD children with 50 typically developing (TD) children, aged 9 to 30 months who had no communication disorders according to the ECSP. During the ECSP test, we analysed joint attention behaviours on three posters present or absent from the children's visual field.

RESULTS

We did not observe any difference in the number of IJAs between groups, but ASD children were less responsive than TD children were. Our results showed a developmental progression in the responses of children with ASD if several deictic cues were used by an adult simultaneously (looking and pointing, or looking and verbalising to indicate a target), whether the referent was present or absent from the child's visual field. In addition, we observed developmental progression when the referent was behind the child and the adult only used their gaze to refer to it.

CONCLUSION

Thus, we argue that the type of cues used affects ASD children's response behaviours during joint attention towards a referent that may be present or absent from their visual field.Implications: Regarding the social and the sensory difficulties of children with ASD, many therapeutic approaches focus their intervention methods on non-verbal communication skills and joint attention. This fundamental research makes it possible to identify the most appropriate type of deictic index for children with ASD with developmental delay, depending on the presence or absence of the referent in the child's visual field.

Teaching Mands for Information Using "Why" to Children With Autism

Mands for information (MFIs) play an important role in language development and are important for successfully acquiring new information from one's environment. Yet many individuals with autism do not acquire mands for information without direct teaching. Research has demonstrated effective procedures for teaching all "wh" forms, except for "why." This study investigated procedures to teach the MFI "why" under control of the establishing operation and examined the extent to which teaching resulted in generalization. The intervention was effective in establishing the MFI "why" for 3 children with autism, and generalization to novel scenarios occurred for all participants.

The mediating role of joint attention in the relationship between motor skills and receptive and expressive language in siblings at risk for autism spectrum disorder

Language problems are highly prevalent in younger siblings of children with autism spectrum disorder (HR-sibs), yet little is known about early predictors. There is growing evidence that motor and language development are linked and this connection might be mediated by joint attention. Developmental changes in motor abilities change how children interact with objects and people (e.g., by showing), which may influence language development. This association has however not yet been studied in HR-sibs. The interrelationship between motor, joint attention and language skills was explored in younger siblings of typically developing children (LR-sibs, N = 31) and HR-sibs (N = 32). In both groups, motor skills (composite of fine and gross motor skills) at 10 months influenced receptive and expressive language at 36 months directly and indirectly through joint attention at 14 months. Group status moderated this direct and indirect effect with mainly significant effects in HR-sibs. This indicates that lower motor skills can have cascading effects on joint attention and language in HR-sibs. Consequently, assessment of early motor skills in HR-sibs might hold promise for early identification of motor difficulties but can also be indicative of language difficulties later in life, especially when difficulties with joint attention are also present.

An Initial Psychometric Evaluation of the Joint Attention Protocol

The goal of this paper is to examine the psychometric properties of a live-coded behavioral measure of joint attention, the Attention-Following and Initiating Joint Attention Protocol (JA Protocol), in order to assist researchers and clinicians in identifying when this measure may meet their joint attention assessment needs. Data from 260 children with autism spectrum disorder, developmental delay, or typical development between the ages of 2 and 12 years were used to evaluate this measure using quality standards for measurement. Overall, the JA Protocol demonstrated good psychometric properties. Recommendations and limitations for use of this measure based on psychometric analysis results are reported.

Increasing Joint Attention in Children with Autism and Their Peers

Joint attention (JA) and peer interactions are significantly impaired in children with autism spectrum disorder (ASD). Empirically demonstrated interventions exist to address JA with adults, but few with peers. Training peers through instructions, modeling (both live and video models), role play, and feedback may help facilitate JA in children with ASD. We examined the effects of peer training with live and video models on typically developing (TD) peer strategies to facilitate JA and JA behavior in children with ASD. TD peers showed some improvement in prompting and reinforcing JA. Children with ASD showed overall increases in JA with trained and novel peers that were also observed by parents, professionals, and peers. Findings are discussed with respect to variables to consider when teaching JA to children with ASD and their peers as well as the need to further examine the relationship between peer training and JA in children with autism.

The relationship between joint attention and theory of mind in neurotypical adults

Joint attention (JA) is hypothesized to have a close relationship with developing theory of mind (ToM) capabilities. We tested the co-occurrence of ToM and JA in social interactions between adults with no reported history of psychiatric illness or neurodevelopmental disorders. Participants engaged in an experimental task that encouraged nonverbal communication, including JA, and also ToM activity. We adapted an in-lab variant of experience sampling methods (Bryant et al., 2013) to measure ToM during JA based on participants' subjective reports of their thoughts while performing the task. This experiment successfully elicited instances of JA in 17/20 dyads. We compared participants' thought contents during episodes of JA and non-JA. Our results suggest that, in adults, JA and ToM may occur independently.

Social Referencing and Children with Autism

During social referencing, infants as young as 6 months of age look to others when confronted with unfamiliar or unexpected events in the environment and then respond to these events based on affective cues of the parent or caregiver (e.g., smiling and frowning). Social referencing is important for early communication and language development. Unfortunately, social referencing repertoires are limited or completely lacking in children with autism. Despite these documented social deficits, little research has focused on ameliorating social referencing deficits. The purpose of this paper is to present a behavior-analytic conceptualization of social referencing and the implications for ameliorating social referencing deficits of children with autism.

Joint attention interventions for children with autism spectrum disorder: a systematic review and meta-analysis

BACKGROUND

A core social-communication deficit in children with autism spectrum disorder (ASD) is limited joint attention behaviours-important in the diagnosis of ASD and shown to be a powerful predictor of later language ability. Various interventions have been used to train joint attention skills in children with ASD. However, it is unclear which participant, intervention and interventionist factors yield more positive results.

AIMS

The purpose of this systematic review and meta-analysis was to provide a quantitative assessment of the effectiveness of joint attention interventions aimed at improving joint attention abilities in children with ASD.

METHODS & PROCEDURES

The researchers searched six databases for studies meeting the inclusion criteria at two levels: title/abstract and full-text stages. Two independent coders completed data extraction using a coding manual and form developed specifically for this research study. Meta-analysis procedures were used to determine the overall effects of several comparisons including treatment type, treatment administrator, intervention characteristics and follow-up.

MAIN CONTRIBUTION

Fifteen randomized experimental studies met inclusion criteria. All comparisons resulted in statistically significant effects, though overlapping confidence intervals suggest that none of the comparisons were statistically different from each other. Specifically, treatment administrator, dosage and design (control or comparison, etc.) characteristics of the studies do not appear to produce significantly different effects.

CONCLUSIONS & IMPLICATIONS

The results of this meta-analysis provide strong support for explicit joint attention interventions for young children with ASD; however, it remains unclear which children with ASD respond to which type of intervention.

Multiple Sensory-Motor Pathways Lead to Coordinated Visual Attention

Joint attention has been extensively studied in the developmental literature because of overwhelming evidence that the ability to socially coordinate visual attention to an object is essential to healthy developmental outcomes, including language learning. The goal of this study was to understand the complex system of sensory-motor behaviors that may underlie the establishment of joint attention between parents and toddlers. In an experimental task, parents and toddlers played together with multiple toys. We objectively measured joint attention-and the sensory-motor behaviors that underlie it-using a dual head-mounted eye-tracking system and frame-by-frame coding of manual actions. By tracking the momentary visual fixations and hand actions of each participant, we precisely determined just how often they fixated on the same object at the same time, the visual behaviors that preceded joint attention and manual behaviors that preceded and co-occurred with joint attention. We found that multiple sequential sensory-motor patterns lead to joint attention. In addition, there are developmental changes in this multi-pathway system evidenced as variations in strength among multiple routes. We propose that coordinated visual attention between parents and toddlers is primarily a sensory-motor behavior. Skill in achieving coordinated visual attention in social settings-like skills in other sensory-motor domains-emerges from multiple pathways to the same functional end.

Conceptualizing Social Attention in Developmental Research

The term social attention has become widely used during the last decade, appearing within behavioral neuroscience and developmental neurocognitive literatures to characterize a variety of activities and cognitive processes that emerge in the presence of conspecifics. We provide here an overview of the current status of social attention as a construct, as reflected in its appearance in research studies, and we offer a framework for characterizing the extant literature based on the functions of social attention processes: as behavior for social communication, as motivation to engage in social communication, and as a form of basic visual attention in the context of other social agents. We then provide two overarching questions to guide future research efforts directed toward establishing the utility of social attention as an independent and/or unified construct. We then consider implications and recommendations for future research efforts.

Methods to improve joint attention in young children with autism: a review

We provide an overview of studies in the past 10 years (2004-2014) that have aimed to improve joint attention (JA) in young children at risk for, or with, autism spectrum disorder. Thirteen randomized controlled trial (RCT) interventions were found, which received particular focus. Three studies used intervention methods with a developmental orientation and focused on caregiver-mediated methods. Others used combined developmental and behavioral approaches and delivered intervention via trained interventionists, caregivers, and teachers. Interventions ranged widely in density, both with respect to the amount of intervention delivered weekly and the total duration of intervention. Fourteen single-subject research design (SSRD) studies and one quasi-experimental pre-post design study were also included. Notably absent in the RCTs were studies using only behavioral methods, while behavioral methods dominated in the SSRDs. The outcomes of the RCTs using combined behavioral and developmental methods generally demonstrate short-term social communication gains. While some studies demonstrated long-term maintenance and positive outcomes in related areas such as language, many did not. The mixed results for language outcomes indicate a need for further investigation. In addition, future studies should further examine participants' developmental readiness and intervention dose in relation to outcome, as well as aim to isolate active ingredients of interventions.

An examination of social interaction profiles based on the factors measured by the screen for social interaction

Deficits in the capacity to engage in social interactions are a core deficit associated with Autistic Disorder (AD) and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). These deficits emerge at a young age, making screening for social interaction deficits and interventions targeted at improving capacity in this area important for early identification and intervention. Screening and early intervention efforts are particularly important given the poor short and long term outcomes for children with Autism Spectrum Disorders (ASDs) who experience social interaction deficits. The Screen for Social Interaction (SSI) is a well-validated screening measure that examines a child's capacity for social interaction using a developmental approach. The present study identified four underlying factors measured by the SSI, namely, Connection with Caregiver, Interaction/Imagination, Social Approach/Interest, and Agreeable Nature. The resulting factors were utilized to compare social interaction profiles across groups of children with AD, PDD-NOS, children with non-ASD developmental and/or psychiatric conditions and typically developing children. The results indicate that children with AD and those with PDD-NOS had similar social interaction profiles, but were able to be distinguished from typically developing children on every factor and were able to be distinguished from children with non-ASD psychiatric conditions on every factor except the Connection with Caregiver factor. In addition, children with non-ASD developmental and/or psychiatric conditions could be distinguished from typically developing children on the Connection with Caregiver factor and the Social Approach/Interest factor. These findings have implications for screening and intervention for children with ASDs and non-ASD psychiatric conditions.

Social-communicative abilities as treatment goals for preschool children with autism spectrum disorder: the importance of imitation, joint attention, and play

Autism spectrum disorder (ASD) is a pervasive developmental disorder with a lifelong impact on multiple domains of functioning. Often, a diagnosis is possible by 3 years of age. Given the benefits of early intervention, it is advisable to start treatment as soon as possible after the diagnosis has been made. Among other factors, early intervention should focus on social-communicative abilities such as imitation, joint attention, and play. In this review, the typical developmental course and functions of these social-communicative abilities are described, and the problems young children with ASD experience in this domain. In addition, different approaches to promoting these abilities are explained. The authors recommend the inclusion of imitation, joint attention, and play as treatment goals in community settings for children with ASD.

See what I see, do as I do: Promoting joint attention and imitation in preschoolers with autism spectrum disorder

Since imitation and joint attention are both important abilities for young children and since children with autism spectrum disorder show a range of problems in these domains, imitation and joint attention are important targets for intervention. In this study, we examined the possibility of promoting imitation and joint attention by means of a training programme specifically designed for low-intensity, non-residential treatment. Two matched groups of 18 children each participated in the study. The experimental group, receiving the training programme, improved significantly more on joint attention than the group receiving only treatment as usual. Only the experimental group obtained a significantly higher imitation score during the post-test compared to the pre-test. This study shows that it is possible to promote joint attention with a low-intensity treatment programme. The results concerning imitation are more modest. Future replications should involve measures of stability and generalization.

Using virtual reality environment to improve joint attention associated with pervasive developmental disorder

The focus of this study is using data glove to practice Joint attention skill in virtual reality environment for people with pervasive developmental disorder (PDD). The virtual reality environment provides a safe environment for PDD people. Especially, when they made errors during practice in virtual reality environment, there is no suffering or dangerous consequences to deal with. Joint attention is a critical skill in the disorder characteristics of children with PDD. The absence of joint attention is a deficit frequently affects their social relationship in daily life. Therefore, this study designed the Joint Attention Skills Learning (JASL) systems with data glove tool to help children with PDD to practice joint attention behavior skills. The JASL specifically focus the skills of pointing, showing, sharing things and behavior interaction with other children with PDD. The system is designed in playroom-scene and presented in the first-person perspectives for users. The functions contain pointing and showing, moving virtual objects, 3D animation, text, speaking sounds, and feedback. The method was employed single subject multiple-probe design across subjects' designs, and analysis of visual inspection in this study. It took 3 months to finish the experimental section. Surprisingly, the experiment results reveal that the participants have further extension in improving the joint attention skills in their daily life after using the JASL system. The significant potential in this particular treatment of joint attention for each participant will be discussed in details in this paper.

Maternal functional speech to children: a comparison of autism spectrum disorder, Down syndrome, and typical development

Children with developmental disabilities benefit from their language environment as much as, or even more than, typically developing (TD) children, but maternal language directed to developmentally delayed children is an underinvestigated topic. The purposes of the present study were to compare maternal functional language directed to children with two developmental disabilities--autism spectrum disorder (ASD) and Down syndrome (DS)--with TD children and to investigate relations of maternal functional language with child language skills. Participants were 60 mothers and their children with TD (n = 20), DS (n = 20), or ASD (n = 20). Children's mean developmental age was 24.77 months (SD = 8.47) and did not differ across the groups. Mother and child speech were studied during naturalistic play. We found (a) similarities in maternal functional language directed to the two groups of children with developmental disabilities compared to that directed to TD children and (b) a positive association between subcategories of information-salient speech and child mean length of utterance in TD dyads only. The clinical and developmental implications of these findings are discussed.